8/02/2010 @ 6:00AM

E-Medical Records: More 'Meaningful Use'

The push toward electronic medical records has garnered a lot of attention lately as the federal rules roll out for public funding of what the government calls “meaningful use.”

But aside from just saving money by modernizing the record keeping, just how meaningful can all of this get? Forbes caught up with Mike Cummins, senior vice president and CIO of VHA, a cooperative national health care network, to discuss the electronic future.

Forbes: What’s the effect of the new meaningful use regulations?

Mike Cummins: It’s occupying the vast majority of our hospitals’ strategy time, and from an IT perspective it’s soaking up any additional time they might have had. From an emergency medical records perspective, to get meaningful use up and operating the CIO, their IT staffs and the CMIOs are just buried right now. We find a lot of our hospitals agree with meaningful use, but the time frame is extremely short. They look to us to make sure we can still supply them with information that’s easy to get to.

How much is useful in terms of cutting costs, and how much is compliance?

There is an undertone in this, from the government’s point of view, of controlling costs. It’s important to note this is controlling costs, not reducing costs. If I do two MRIs because I didn’t know about one of them, that’s an unnecessary cost. But meaningful use also can mean a healthier patient. It’s always been about what will be the best outcome for the patient. That’s what our hospitals are all about. How do these rules help us provide higher quality care to our patients? If it helps prevent someone from giving the wrong drug to the patient or the wrong dose, that’s clearly in the patient’s best interest. It’s not just whether we’re following rules. It’s whether we’re doing things that help our patients have a better outcome. It might feel like it’s all about cost, but the people who are deep in this are worried about the patient.

But it is about efficiency, even if that’s not necessarily cost, right?

Absolutely. We have a lot of clinical strategies that are delivered even on mobile applications that help with better practices. We do things like blueprints here that have some of the highest ratings in areas like heart care. If you get aspirin, did you get a beta blocker in a certain time frame? That’s been proven to help dramatically. We make those available to our other members online, and we will spend time working with them. Those applications also are available to our members using mobile applications on the iPhone and, in the near future, on iPad. We’re helping them look at who is doing this extremely well and how to implement procedures in their own organization, whether it’s in hospitals, on the road and in a facility where they can talk about it on a mobile device.

Can you mine data and draw trends, too?

Yes. We do that on a regular basis. We have products like Executive View, which comes out of our clinical area, and a group in Atlanta that provides in-depth looks into cardiac, cath [catheter] lab and orthopedics, that extracts that information and makes it available to our organizations and to benchmark against others, as well.

Does that apply to treatments, as well?

Yes. For example, we can see whether or not a bare metal stint is better in all populations. In general, we’re looking at the effectiveness of a stint. It’s a high-cost item, and we can see if one brand is doing better than another in a population. We can see whether a hip replacement treatment is doing well and whether the patient is out of the hospital and not having to come back multiple times, or whether they have an infection. We’re trying to help our hospitals figure out what is the best and most efficient care at the best cost. That turns out to be the best care for our patients at a reasonable cost.

Can you also determine the utilization of specialists?

We don’t try to decide how many you need. That’s based on the need of the population in your area. There are companies, including the hospitals themselves, who are familiar with the population dynamics in their area. There are formulas that say for this type of population with these kinds of conditions you need this number of specialists. That won’t give you an exact number, but you can get close enough. We won’t deal with that. What we want to do is take best practices and be able to move them from one place to another.

Is there an average amount of time for that to happen?

Yes, it can take up to seven years for a best practice to move through the medical community. That’s a problem if you’re a patient and after six years it hasn’t gotten to your medical community. The problem is that it often gets recreated. That’s where we’re working on getting knowledge created in any one of our organizations out to all of our organizations. We think that’s a huge benefit, both to our hospitals and our patients.

How fast can best practices be moved and understood?

We think we can do it within a year, which is significantly faster than if you let it go by word of mouth. We use structured methodologies to do it. If you look at our clinical applications, we say how it was done and we have all the other documentation that often is a roadblock. Even governance documents can be a roadblock. A lot of times you can get the diagram of how to move from A to B, but you can’t get the rest of the knowledge that helps you move that. We provide the blueprints and the underpinnings to take it to an institution, change a few lines, and it becomes a template in the organization.

Are these open documents that can be modified?

We’re always looking at updating and adding new best practices to our portfolio. Right now we have 100 of those, and we continue to grow that number.

Database management can be incredibly time-consuming. Is that a burden?

We see that as a part of what we have to be doing all the time–maintaining that data. These best practices come from our hospitals, so they’re highly involved. This is a cooperative effort–VHA is a cooperative–so if they find improvements they’ll help us update that information. They find high value in extracting information. We manage it, but our hospitals help us gather that information.

How is all this shared?

If we look at all the things we do, everything is thought of in terms of the best way to put it in people’s hands. Everything is Web-based. In some cases, we’ll create dashboards. And finally, we have e-mail and mobile applications, which is another way of delivering a Web-based application. Now we’re going to our mobile applications, and that’s a refinement of the Web-based. We always said we want to give people information at the moment in time when they need it.

Ed Sperling is the editor of several technology trade publications and has covered technology for more than 20 years. Contact him at esperlin@yahoo.com.